Organization
PHOENIX SPINE GOODYEAR ASC, LLC
Active
Other names
Phoenix Spine Goodyear ASC, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (AO)
(480) 567-0269
Entity
Organization
Contact information
Practice address
140 N LITCHFIELD RD, SUITE 110, GOODYEAR, AZ 85338-1277
(602) 256-2525
(602) 256-0795
Mailing address
140 N LITCHFIELD RD STE 110, GOODYEAR, AZ 85338-1226
(602) 256-2525
(602) 256-0795
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
28519
AZ
208100000X
Physical Medicine & Rehabilitation Physician
35838
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
987125
—
AZ
Enumeration date
11/20/2006
Last updated
09/05/2024
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